Organization
EFRAIN GONZALEZ GRAJALES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EFRAIN GONZALEZ (OWNER)
(787) 460-9077
Entity
Organization
Contact information
Practice address
RD 125 KM 0.4 INT, CAMINO CORDERO, BO PALMAR, AGUADILLA, PR 00603
(787) 460-9077
(787) 818-0429
Mailing address
HC 02 BOX 21953, AGUADILLA, PR 00603-1953
(787) 460-9077
(787) 818-0429
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
P1080
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70521
PREFERRED MEDICARE CHOICE
PR
Enumeration date
04/25/2007
Last updated
03/26/2010
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